Ischemic Heart Disease

Question 1

What is ischemic heart disease?

Answer 1

Reduction of blood flow to the heart muscle, usually due to CAD=coronary artery disease (artherosclerosis of coronary arteries)

Question 2

3 symptoms of ischemic heart disease

Answer 2

1. Angina (chest pain) - reversible
2. MI (plaque ruptures; 20 mins or more angina) - irreversible
3. Congestive Heart Failure (lots of damage from MI that it causes heart failure)

Question 3

Angina Etiology

Answer 3

compromise in coronary blood flow

Question 4

Angina Signs and symptoms

Answer 4

pain in chest, arms, back, jaw

SOB, diaphoresis (sweat) →w/ MI, get more severe + prolonged chest pains than with angina

Question 5

Angina prognosis

Answer 5

may progress to MI (usually if pain lasts more than 20 mins its MI)

Question 6

Angina - nonpharm treatment

Answer 6

1. lifestyle modifications

2. risk factor modifications

Question 7

Angina - 5 meds

Answer 7

1. Beta Blockers
2. CCB
3. Nitrates
4. Antiplatelet agents
5. Statin

Question 8

Mechanism of statins

Answer 8

they lower cholesterol levels by inhibiting HMG-CoA reductase enzyme (which produces cholesterol in liver)

Question 9

What do nitrates do?

Answer 9

Vasodilators, increase coronary blood flow

Question 10

List 2 nitrates

Answer 10

1. Nitrodur

2. Minitran (patches that you put on a night)

Question 11

What are antiplatelets?

Answer 11

(antiaggregant) decrease platelet aggregation and inhibit thrombus formation.

Question 12

List 4 statins

Answer 12

1. Lovastatin
2. Atorvastatin
3. Rosuvastatin
4. Simvastatin

Hint - Statin

Question 13

Angina - Treatment surgery

Answer 13

1. Coronary Angiography
2. Angioplasty and stenting
3. Coronary Artery Bypass

Question 14

Unstable Angina

Answer 14

change in patten of [normal] angina

Question 15

Treatment of unstable angina

Answer 15

1. similar to angina but its a medical emergency

2. admit to hospital

Question 16

Unstable angina - meds

Answer 16

1. intravenous beta blockers (blood thinners)
2. antiplatelets
3. anticoagulation
4. intervention

Question 17

MI - Etiology

Answer 17

Acute occlusion of a coronary artery

Question 18

MI - S&S

Answer 18

more severe/ prolonged chest pain (angina)

Question 19

MI - Prognosis

Answer 19

out versus in hospital mortality

Question 20

MI - Acute Therapy Treatment (3)

Answer 20

1. CCU admissions
2. Thrombolytic (breakdown clot)
3. Cardiac catheterization

Question 21

MI - Chronic Therapy Treatment (2)

Answer 21

1. That of angina

2. +/- ACE inhibitors

Question 22

IHD - Dental Considerations according to CCS (Canadian Cardiac Society)

Answer 22

I - Asymptomatic
II - Angina walking 2 blocks and 1 stairs
III - Angina walking less than 2 blocks and 1 stairs
IV - Symptomatic at rest

*No dental surgery at III and IV b/c its too severe

Question 23

When is it an IHD emergency

Answer 23

1. If unstable symptoms = emergency room
2. Continue cardiac meds perioperatively
3. Avoid exacerbating factors - pain, vasopressors (constrictors), emotional stress